Background: Obesity and cancer are recognized worldwide health threats. While there is no reported causal relationship, the increasing frequency of both conditions results in a higher incidence of obese patients who are being treated for cancer. Physiological data indicate that there is a relationship between obesity and susceptibility to pain; however, currently, there are no specific pharmacological interventions. Objective: To evaluate the self-reported intensity of postoperative pain in obese and nonobese lung cancer who receive either thoracotomy or video-assisted thoracic surgery (VATS) surgical therapy. Material and Methods: In 50 obese [mean body mass index (BMI) of 34.1 ± 3.2 kg/m 2 ] and 62 nonobese (mean BMI of 24.9 ± 3 kg/m 2 ) lung cancer patients, the intensity of pain was estimated every 4 h using a visual analog scale (VAS, 0 indicating no pain and 10 indicating “worst imaginable pain”) beginning shortly after surgery (Day O) and continuing until the day of discharge (Day D). Results: The self-reported pain was more severe in obese than in nonobese patients, both at the time of the operation [Day O (4.5 ± 1.2 vs 3.4 ± 1.1; p < 0.0001)] and at the day of discharge [Day D (3.9 ± 1.4 vs 2.6 ± 0.9, p < 0.0001)]. This finding was consistent both in the patients after thoracotomy and after video-assisted thoracic surgery (VATS, p < 0.0001). The patients with severe pain shortly after surgery (VAS score >4) had significantly higher BMI (31.8 ± 5.6 kg/m 2 vs 28.8 ± 5.2 kg/m 2 , p < 0.01) and were hospitalized longer than the remaining patients (13.0 ± 13.6 days vs 9.5 ± 3.6 days, p < 0.05). Conclusion: The reported perception of pain in obese lung cancer patients is greater than in nonobese patients undergoing the same thoracic surgery. In obese patients, severe pain persisted longer. Pain management is an important consideration in the postoperative care of lung cancer patients, even more so with obese patients.
Rheumatoid arthritis (RA) is an inflammatory immune-dependent systemic connective tissue disease leading to joint destruction and organ complications. Recent years have seen a strong interest in manual therapy and its possible use in patients with pain and limited joint mobility. This prompted us to evaluate the effectiveness of joint mobilization in a patient with RA. The present paper assesses the effects of a joint mobilization technique on pain and functionality of the hand and wrist in a patient with rheumatoid arthritis.
Purpose. To assess the loco-regional distribution pattern of a blue dye tracer, as a surrogate for a chemotherapeutic agent, injected in the invasion edge of resectable lung tumor; to evaluate the technique efficacy at staining the lung-tumor interface and the metastatic pathways. Methods. Between November 2014 and September 2015, we enrolled 33 patients (17 women, 16 men; 52-87 years old) presenting with 31 primary lung carcinomas and 2 metastases. We injected in vivo (n=17) or ex vivo (n=16) the innermost side of the tumor invasion edge with 1.3ml methylene blue dye. We performed the injection alone (n=12) or combined with a focal freezing (n=21). We assessed the stain distribution into the invasion-edge, the tumor, the lung or the node(s) at gross and microscopic examination. Results. At gross examination, we observed a quick, intense staining of the invasion edge, and a concomitant staining of the tumor and the lung. The staining pattern was heterogeneous in the tumor, homogeneous in the invasion edge and the lung irrespective of the focal freezing, tumor type, size, or blood perfusion status. The microscopic examination evidenced the staining of the matrix, vessel lumens, and tumor cells, except for lymph nodes. Conclusions. The inner side of the invasion edge looks a suitable location for directly injecting and distributing the methylene blue tracer within the interstitium and related draining pathways during the resection of primary or secondary lung tumor. Fresh resection specimens are convenient to evaluate new edge-targeting injections techniques for the diagnostic or therapeutic management of cell dissemination during surgery.Many studies suggest that surgery has a pro-metastatic effect potential, likely affecting the disease free survival (DFS) and the overall survival (OS) rates [3,4,5,6]. The search for new multimodal anti-metastatic therapeutic strategies has lead oncologists to consider the initiation of adjuvant chemotherapy during the perioperative period, regarded as a "window of opportunity [3], and/or the locoregional administration of active agent (s) [7]. Many advocate a more systematic use of the combination of adjuvant chemotherapy and resection for early lung cancer [8].The metastatic dissemination, arising from a growing tumor, a surgical resection [5,6] or a biopsy [9] involves cells shedding within the tumor interstitium and the aerial, hematogenous and/or lymphatic drainage pathways, [10,
Obesity and sarcopenia, i.e., decreased skeletal muscle mass and function, are global health challenges. Moreover, people with obesity and sedentary lifestyles often have sleep disorders. Despite the potential associations, metabolic disturbances linking obesity, sarcopenia, and sleep disorders with cancer are neither well-defined nor understood fully. Abnormal levels of adipokines and adipomyokines originating from both adipose tissue and skeletal muscles are observed in some patients with obesity, sarcopenia and sleep disorders, as well as in cancer patients. This warrants investigation with respect to carcinogenesis. Adipokines and adipomyokines may exert either pro-carcinogenic or anti-carcinogenic effects. These factors, acting independently or together, may significantly modulate the incidence and progression of cancer. This review indicates that one of the possible pathways influencing the development of cancer may be the mutual relationship between obesity and/or sarcopenia, sleep quantity and quality, and adipokines/adipomyokines excretion. Taking into account the high proportion of persons with obesity and sedentary lifestyles, as well as the associations of these conditions with sleep disturbances, more attention should be paid to the individual and combined effects on cancer pathophysiology.
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